Prostate Cancer Detection with mpMRI According to PI-RADS v2 Compared with Systematic MRI/TRUS-Fusion Biopsy: A Prospective Study

BACKGROUND: mpMRI assesses prostate lesions through their PI-RADS score. The primary goal of this prospective study was to demonstrate the correlation of PI-RADS v2 score and the volume of a lesion with the presence and clinical significance of prostate cancer (PCa). The secondary goal was to determine the extent of additionally PCa in inconspicuous areas. METHODS: All 157 patients underwent a perineal MRI/TRUS-fusion prostate biopsy. Targeted biopsies as well as a systematic biopsy were performed. The presence of PCa in the probes was specified by the ISUP grading system. RESULTS: In total, 258 lesions were biopsied. Of the PI-RADS 3 lesions, 24% were neoplastic. This was also true for 36.9% of the PI-RADS 4 lesions and for 59.5% of the PI-RADS 5 lesions. Correlation between ISUP grades and lesion volume was significant (p < 0.01). In the non-suspicious mpMRI areas carcinoma was revealed in 19.7% of the patients. CONCLUSIONS: The study shows that the PI-RADS v2 score and the lesion volume correlate with the presence and clinical significance of PCa. However, there are two major points to consider: First, there is a high number of false positive findings. Second, inconspicuous mpMRI areas revealed PCa

The expression of mucins, keratins and of CDX-2 in Barrett's Esophagus. A histochemical and immunohistological examination

Das Adenokarzinom des Ösophagus ist weltweit der Tumor mit der stärksten Zunahme der Prävalenz in den letzten 25 Jahren. Die Prognose, besonders in fortgeschrittenen Stadien, ist generell ungünstig. Unsicherheiten in der endoskopischen, wie auch in der histologischen Diagnostik erschweren die Risikoeinschätzung für den einzelnen Patienten. Der einzige anerkannte Risikofaktor für das Entstehen eines Adenokarzinoms des unteren Ösophagus ist die Barrett-Mukosa. Die histologische Diagnose der Barrett-Mukosa ist nur bei einem Nachweis von Becherzellen in der metaplastischen Schleimhaut möglich (no goblets - no Barrett's). Wir konnten in der vorliegenden Arbeit an 56 Biopsien zeigen, dass es bereits vor dem Nachweis von Becherzellen möglich ist, eine Barrett-Mukosa histologisch zu diagnostizieren. Mit Hilfe der in der histologischen Routine einfach handzuhabenden Muzinfärbung nach Mowry und dem immunhistochemischen Nachweis des homeodomain Proteins CDX-2, fanden wir eine Schleimhautveränderung im unteren Ösophagus, die wir als beginnende Barrett-Mukosa bezeichnen. Diese beginnende Barrett-Mukosa zeigt eine Expression von sauren Muzinen in der Färbung nach Mowry. CDX-2 wird hier fokal in den Kernen oder zytoplasmatisch exprimiert. Die beginnende Barrett-Mukosa weist keine Becherzellen auf und zeigt daher keine Expression von MUC-2. Wir konnten ferner zeigen, dass das von Ormsby vorgeschlagene Barrett-Muster der Zytokeratine CK-7 und CK-20 in der täglichen Routine nicht für die Unterscheidung der intestinalen Metaplasie der Magenkardia von der Barrett-Mukosa geeignet ist. Mit dem Nachweis einer beginnenden Barrett-Mukosa in Biopsien aus dem unteren Ösophagus ist es möglich schon frühzeitig ein erhöhtes Risiko für die Entstehung eines Adenokarzinoms des Ösophagus zu erkennen. Weitere Studien sind notwendig um die Prognose der betroffenen Patienten einschätzen zu können.Adenocarcinoma of the esophagus is the entity with the highest rise in prevalence over the last 25 years. Prognosis especially in advanced stages is poor. Inconsistency in endoscopic as well as in histologic diagnosis leads to problems in risk evaluation. Barrett's mucosa is recognized as the major risk factor for the development of adenocarcinoma of the esophagus. The histologic diagnosis of Barrett's mucosa requires the presence of goblet cells (no goblets - no Barrett's). We could show on 56 biopsies that it is possible to make the diagnosis of Barrett's mukosa before goblet cells are present. With use of Mowry's mucin stain and the detection of the homeodomain protein CDX-2 we could demonstrate changes in the esophageal mucosa which we consider to be a beginning Barrett's mucosa. This beginning Barrett's mucosa shows an expression of acidic mucines in Mowry's mucin stain. CDX-2 is expressed cytoplasmatically or shows a focal core expression. There are no goblet cells within the beginning Barrett's mucosa and therefore staining for MUC-2 is negative. We could also demonstrate that the so called Barrett's pattern of the Cytokeratins CK-7 and CK-20 proposed by Ormsby is not useful in daily practice for the differentiation between intestinal metaplasia of the cardia and Barrett's mucosa. With the beginning Barrett's mucosa it is now possible to predict early an increased risk for the development of adenocarcinoma of the esophagus. Further studies are required to evaluate prognosis of the patients

Prostate Cancer Detection with mpMRI According to PI-RADS v2 Compared with Systematic MRI/TRUS-Fusion Biopsy: A Prospective Study

Background: mpMRI assesses prostate lesions through their PI-RADS score. The primary goal of this prospective study was to demonstrate the correlation of PI-RADS v2 score and the volume of a lesion with the presence and clinical significance of prostate cancer (PCa). The secondary goal was to determine the extent of additionally PCa in inconspicuous areas. Methods: All 157 patients underwent a perineal MRI/TRUS-fusion prostate biopsy. Targeted biopsies as well as a systematic biopsy were performed. The presence of PCa in the probes was specified by the ISUP grading system. Results: In total, 258 lesions were biopsied. Of the PI-RADS 3 lesions, 24% were neoplastic. This was also true for 36.9% of the PI-RADS 4 lesions and for 59.5% of the PI-RADS 5 lesions. Correlation between ISUP grades and lesion volume was significant (p < 0.01). In the non-suspicious mpMRI areas carcinoma was revealed in 19.7% of the patients. Conclusions: The study shows that the PI-RADS v2 score and the lesion volume correlate with the presence and clinical significance of PCa. However, there are two major points to consider: First, there is a high number of false positive findings. Second, inconspicuous mpMRI areas revealed PCa